NCPA CEO Addresses Independent Pharmacy Opportunities, Initiatives

In his annual address to NCPA’s 2012 national meeting of independent community pharmacists, CEO B. Douglas Hoey, RPh, MBA touched on a diverse array of association and industry initiatives.

Here below are key excerpts of his remarks:

Part of NCPA’s mission is to help community pharmacists find solutions during uncertain times.

Advocacy is NCPA’s calling card. This year we are working on legislation that would require PBMs working in government programs to be more transparent with MACs and conduct audits fairly and equitably.

Additionally, we are advocating for legislation exempting most independent pharmacies from the competitive bid program for diabetes strips — a program that favors big mail order suppliers.

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NCPA continues to dedicate major resources to the federal government and federal agencies. But NCPA has also made the commitment to significantly increase its focus on state legislatures and state regulatory agencies, where we continue to see more – ideas for regulation and legislation.

We have increased the resources we are providing to help those states targeting MAC and PBM audit issues in 2013. With input from NCPA membership committees and others, we have created model mail order, audit, PBM, and MAC legislation. These model bills, especially the audit model bill, have been enacted in more than a dozen states. We are grateful for the support of NASPA, the state associations, and Independent Pharmacy Organizations who we partner with to help drive these issues!

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Last year we announced the formation of a Legal Resource Center—that would provide a centralized repository for community pharmacy representatives to learn from earlier key cases impacting pharmacy.

The idea is that when legal action is necessary, this legal library will increase precision, efficiency, and most of all, chances of success.

I’m pleased to announce that this new resource is now up and available to NCPA members. It has close to 100 cases in its library. It includes summaries of big-picture issues like corporate lawsuits, antitrust challenges and smaller day-to-day legal issues.

Be sure to check out this important new resource.

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Last month we amended a federal lawsuit challenging the merger of ESI and Medco due to the anticompetitive effects its unprecedented market power has and will have on community pharmacy and patients.

In August, the judge upheld our claim in the original complaint brought by NCPA, NACDS and 9 Pennsylvania pharmacies about the impact of the merger on specialty pharmacies and their patients. She also allowed us to amend other claims in our complaint.

Now some may ask why we are continuing the case.

Are we litigious? Not particularly.

Are we gluttons for punishment? Definitely not.

Do we think we have a chance? Absolutely!

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Another reason for community pharmacies to aggregate is specialty medications.

They are an enormous opportunity… or threat for community pharmacies. Last year prescription drug spending went up only 1 percent due to the numerous new generics that entered the marketplace.

But the amount spent on specialty drugs increased nearly 20 percent. Independent pharmacies are perfectly positioned for all facets of these medications which often require special storage, special administration, special counseling, and special measures to ensure adherence.

They are independently owned and operated and have 220 pharmacies in their network. NCPA will continue to work with CSPN and others to encourage participation by independents in specialty pharmacy.

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Maybe one of the most fundamental things independent pharmacies can do is to help patients stay on their medicine. We could help address economic uncertainty in healthcare and manage chronic conditions if we could help patients take the right medications at the right time.

Adherence is the perfect first step for pharmacists because it’s a clinical service that is in demand by health systems—especially those that want to boost their Medicare star rating or improve readmission rates. Medication adherence is the right thing to do to help patients stay healthy and out of the hospital.

And, it’s a service that—even though we should be paid for improving adherence—increases pharmacy revenue by increasing the number of prescriptions dispensed.

So far over 500 pharmacies have signed up for NCPA’s Simplify My Meds. Simplify My Meds is a FREE program for NCPA members to help them increase patient adherence.

Pharmacies in the program report higher revenue, better inventory management, and the ability to smooth out the peaks and valleys of prescription volume throughout the day.

As the 2012 election sets in and healthcare reform takes root, the healthcare landscape will become dotted with ACOs and colored by aggressive payment reform. The formation of connected (PBM technology) ACO healthcare teams will ultimately determine efficiency and drive a vast majority of beneficial cost savings inside PPACA
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Independent Pharmacist must have PBM representation and PBM technology in this now mandated ACO market place. PBM representation is extremely important in the case of independent pharmacies because they do not have the already-existing infrastructure of regional and/or national networks to contract with an ACO, medical home, or a Passport in Kentucky to offer services and negotiate terms of contract participation.

Without this regional and/or national infrastructure new ACO contracts will be like the old PBM contracts; Take it, leave it or not even be invited to the dance.

Why Pharmacists must have PBM technology to accomplish their clinical skills.

The prescription benefit, anchored by the EMR, supports the use of pharmacists as they monitor drug therapies for the entire patient population.
In addition, it will be important for the prescription benefit to be seamlessly integrated with the case management, disease management and medications therapy management programs (MTM) that the ACO, health plan and/or hospitals employ. This will take integration of PBM information technology systems and clinical programs in order to deliver coordinated messaging to patients about their healthcare. The integration of these programs will lead to improved outcomes and, ultimately, decreased costs across the ACO.

Independent pharmacists have the “ability” to form an infrastructure similar to the national chains to service government and ACOs, but they have consistently failed to show a “willingness” to do so. The first obstacle independents need to address is this reluctance to give up some “independence” in order to be relevant and competitive in the evolving ACO prescription benefit health care marketplace.

So as someone who does not have a lot of understanding doe sthi mean that independent pharmacies will struggle getting prescriptions if larger organizations such as Sutter form contracts with chain pharmacies.